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CCSVI (Chronic cerebrospinal venous insufficiency)

Chronic cerebrospinal venous insufficiency (CCSVI) is a theory that suggests abnormalities (including narrowing) of the veins draining blood from the brain and spinal cord may contribute to the nervous system damage in multiple sclerosis.

CCSVI was proposed by Professor Paolo Zamboni, a vascular surgeon. His original study of 65 people with MS found narrowing of the jugular vein in 91% and of the azygous vein (in the spine) in 86%. These abnormalities were not seen in a control group of people who didn't have MS.

Numerous studies have now been carried out by different research groups but findings have been contradictory. Generally CCSVI was more frequent among people with MS than amongst healthy controls, however, the prevalence of CCSVI in both people with MS and controls varied widely.

Proposed treatment for CCSVI

It has been proposed that CCSVI can be treated with a surgical procedure known as percutaneous venoplasty, which is sometimes referred to as the 'liberation therapy'. This procedure aims to open blocked veins by inflating a small balloon in the vein. In some instances the vein is kept open by inserting a stent - a small mesh tube. Studies have found that, following the procedure, blockages have recurred in a high proportion of people.

Research

A number of research studies have investigated the association between venous insufficiency and MS. Whilst many of these demonstrate that CCSVI is not a cause of MS, debate remains as to whether it is a cause of MS symptoms, arises as a result of MS, or is completely unrelated to MS and just coincidental.

The benefits of surgical intervention also needs to be fully assessed in controlled clinical trials. NICE guidance published in March 2012 stated that current evidence on the efficacy of percutaneous venoplasty for CCSVI in MS is inadequate in quantity and quality and the surgical procedure should only be used in the context of clinical trials.

NICE has recommended further research on percutaneous venoplasty for CCSVI in MS in the form of robust clinical trials and recommends that studies should have clearly defined selection criteria, good definitions of technical success and outcomes that include clinical and quality of life measures.

 

More references

  • Zamboni P, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry 2009;80:392-399. Full article
  • Laupacis A, et al. Association between chronic cerebrospinal insufficiency and multiple sclerosis: a meta-analysis. Canadian Medical Association Journal 2011:183(16):e1203-e1212. Full article
  • National Institute for Health and Clinical Excellence. Percutaneous venoplasty for chronic cerebrospinal venous insufficiency for multiple sclerosis. London; NICE: 2012. Full guidance
  • Torres C, et al. Extracranial venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant? European Radiology 2016 Mar 24. [Epub ahead of print]

Last reviewed: 22 May 2014
Last updated: 8 June 2016
This page will be reviewed within three years

More references

  • Zamboni P, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry 2009;80:392-399. Full article
  • Laupacis A, et al. Association between chronic cerebrospinal insufficiency and multiple sclerosis: a meta-analysis. Canadian Medical Association Journal 2011:183(16):e1203-e1212. Full article
  • National Institute for Health and Clinical Excellence. Percutaneous venoplasty for chronic cerebrospinal venous insufficiency for multiple sclerosis. London; NICE: 2012. Full guidance
  • Torres C, et al. Extracranial venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant? European Radiology 2016 Mar 24. [Epub ahead of print]

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